RESUMO
BACKGROUND: The study of perioperative drug reactions remains a major challenge for both diagnosis and therapy. The lack of a standard assessment of allergy to general anesthetics and of data establishing the true value of skin tests for most drugs used in induction and maintenance of anesthesia, as well as the lack of commercially available reagents for in vitro tests, renders the study of these reactions problematic. The aims of this study were to provide a diagnostic protocol for drug challenge testing with general anesthetics, to establish an etiological diagnosis that is as specific as possible, and to determine the predictive value of skin tests. METHODS: Twenty-nine patients with perioperative drug reactions were included in the study from November 2008 to December 2018. RESULTS: We confirmed the high negative predictive value of the tests (96%-100%) in the case of propofol, rocuronium, and fentanyl. To our knowledge, this is the first study to describe drug challenge testing with general anesthetics and, therefore, to establish the true negative predictive value of skin tests, which leads to a definitive diagnosis and safer surgery. CONCLUSIONS: After assessing risks and benefits and considering the importance of this group of drugs, we conclude that drug challenge testing with general anesthetics is necessary. We propose a protocol for perioperative drug reactions that enables us to make a highly accurate etiological diagnosis with minimum risk for the patient.
Assuntos
Anestésicos Gerais/efeitos adversos , Hipersensibilidade a Drogas/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Analgésicos Opioides/efeitos adversos , Anestésicos Intravenosos/efeitos adversos , Atracúrio/efeitos adversos , Atracúrio/análogos & derivados , Feminino , Fentanila/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Bloqueadores Neuromusculares/efeitos adversos , Período Perioperatório , Valor Preditivo dos Testes , Propofol/efeitos adversos , Remifentanil/efeitos adversos , Rocurônio/efeitos adversos , Testes Cutâneos , Sugammadex/efeitos adversos , Adulto JovemAssuntos
Anafilaxia/etiologia , Vacinas contra COVID-19/efeitos adversos , COVID-19/prevenção & controle , Hipersensibilidade a Drogas/etiologia , Excipientes/efeitos adversos , SARS-CoV-2/imunologia , Vacinas Sintéticas/efeitos adversos , Vacina de mRNA-1273 contra 2019-nCoV , Adulto , Idoso , Anafilaxia/diagnóstico , Vacina BNT162 , Hipersensibilidade a Drogas/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Testes Cutâneos , Inquéritos e Questionários , Vacinas de mRNARESUMO
BACKGROUND: The most frequent non-immediate reactions described with iodinated contrast media (ICM) are mild to moderate, however, some cases of patients with severe non-immediate reactions, such as drug eruption with eosinophilia and systemic symptoms (DRESS) have been described. CASE PRESENTATION: An 84-year-old patient developed DRESS syndrome after administration of ICM ioversol. The patient fullfilled the RegiSCAR diagnostic criteria for DRESS (definite score = 6). He underwent intradermal skin testing (IDT) with the widest panel of ICM available at our center. IDT was positive with ioversol and iomeprol. A punch biopsy was performed on the positive IDT with the culprit drug (ioversol) and histopathology was compatible with a T-cell mediated mechanism. CONCLUSION: In this case, the IDT-positive biopsy was consistent with DRESS syndrome caused by T-lymphocyte activation, supporting the clinical diagnosis.
RESUMO
TITLE: Tratamiento del angioedema orolingual inducido por alteplasa mediante icatibant.
Assuntos
Angioedema/induzido quimicamente , Angioedema/tratamento farmacológico , Anti-Inflamatórios não Esteroides/uso terapêutico , Bradicinina/análogos & derivados , Fibrinolíticos/efeitos adversos , Doenças da Boca/induzido quimicamente , Doenças da Boca/tratamento farmacológico , Ativador de Plasminogênio Tecidual/efeitos adversos , Bradicinina/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Doenças da Língua/induzido quimicamente , Doenças da Língua/tratamento farmacológicoRESUMO
Fixed drug eruptions due to ibuprofen have rarely been reported. Two days after treatment with ibuprofen, a 61-year-old woman developed erythema and pain affecting the tongue and oral mucosa. Two months later, the patient started ibuprofen and erythromycin for a catarrhal episode with reappearance of the same lesions in the oral mucosa 24 hours later. Furthermore, two new erythematosus-violaceous maculae developed. Topical challenge through an occluded patch test with ibuprofen 5% on the residual cutaneous lesion was successful. We present an unusual case of fixed drug eruption due to ibuprofen